Your Right to Know

WASHINGTON — U.S. officials yesterday gave four states currently governed by Republicans the
green light to set up their own health-insurance exchanges under President Barack Obama’s
health-care law, an initiative largely opposed by Republicans.

The U.S. Department of Health and Human Services said Idaho, Nevada, New Mexico and Utah joined
a list totaling 17 states and the District of Columbia that all have won conditional approval to
establish their own state exchanges, with operations set to begin on Jan. 1, 2014.

A fifth Republican-led state, Mississippi, applied to operate a state exchange but has not
received approval because of a dispute about how much authority state officials should exercise
over the operations of its prospective online marketplace, officials said.

The U.S. administration also cleared an exchange that Arkansas plans to run in partnership with
the federal government. Delaware received approval for a similar partnership exchange late last
year. Both Arkansas and Delaware have Democratic governors.

Health exchanges are a central provision of the Patient Protection and Affordable Care Act. The
marketplaces would extend health coverage to an estimated 16 million uninsured people by allowing
them to purchase private insurance at prices subsidized by federal tax credits.

In a conference call with reporters, Health and Human Services Secretary Kathleen Sebelius
welcomed the exchanges as “a brand-new day” for U.S. health care that would “drive down costs” for
consumers through competition.

But many Republicans view the health-care law as a costly and unnecessary expansion of
government bureaucracy.

The federal government likely will end up operating exchanges in at least 32 states, including
Ohio, that have not applied to run their own. States have the choice of rejecting the exchange
provision outright, or following Delaware and Arkansas by participating in federal partnership
exchanges that would allow them to manage insurance plans and aid consumers.

The deadline for states to declare their intentions to run partnership exchanges is Feb. 15.

Oklahoma has asked a U.S. judge to prevent the administration from using tax credits to
subsidize insurance sold in federal exchanges in that state.

U.S. officials said states that are unable to begin open enrollment by October can apply in
November to run their own marketplaces in 2015.